BALLET SCHOOL - REGISTRATION FORM

Myra Mier School of Ballet
Registration Form

Student Information, required fields marked with a *
*Student's Name:
Birth Date (mm/dd/yy)
Current Age
Home Phone (include area code)
Cell Phone (include area code)
Emergency Contact Name
Emergency Contact Number
*Mailing Address:
*City:
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*Zipcode:
*Email
Past Ballet Training:
Years
Studio
Father's Name
Occupation/Place of Employment
Mother's Name
Occupation/Place of Employment

If you would like further information please call (504) 468-1231. A non refundable registration fee of $35.00 will hold a student's place in the class. You will be contacted with a schedule of class times.

Myra Mier School of Ballet
3621 Florida Avenue
Kenner, Louisiana 70065
(504) 468-1231